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Case Study: The Uninsured


The New Physician September 2000
One in six Americans does not have health insurance, and many live sicker and die younger because of it. The ones Dr. Debra Richter thinks of are dead—like George and his sister, Tina. Richter took care of them at an inner-city health center in Buffalo, New York. Diabetics since childhood, their disease went untreated because the family rarely had health insurance. When they were teenagers, Tina waitressed and George worked in factories. None of their employers offered them health insurance. They earned too much money to qualify for Medicaid, and they couldn’t afford to buy private insurance, so they went without insulin, syringes and glucometer sticks.

“I’d talk drug companies into giving us free bottles of insulin,” Richter says, “but you just don’t keep free samples of insulin lying around. Syringes were fairly easy to scrounge, but at 50 cents each, glucometer sticks were difficult to get.”

With blood sugar levels averaging 200, George went blind at age 20. Unable to see or work, depressed and housebound, his disability finally qualified him for Medicaid—too late. He died at age 21 of multiple organ failure due to uncontrolled diabetes.

Tina’s first and only baby lived for five months and never left the hospital. Cause of death: complications from gestational diabetes. A year later, Tina had a myocardial infarction. Despite a bypass, she died at age 25. “It was heartbreaking,” Richter says. “George and Tina had a strong work ethic. I had to face their mother at the funerals knowing if they had gotten good care for diabetes, we could have prevented all their end organ disease. George would not have gone blind. The baby would have lived. Neither would have had heart or kidney problems.”

“I see stories like these every day,” Richter says, “but the public never hears them because they’re anecdotal. The cause of death says kidney failure, but they really died from lack of insurance.”